New initiatives and new treatments mean there is fresh hope in the battle against cervical cancer in Africa, says David Kerr
EVERY 10 minutes, a woman in Africa dies from cervical cancer. This is despite the fact that almost every case is preventable through a programme of screening, treatment and vaccination against the human papilloma virus which causes the disease.
Each year, more than 60,000 women in Africa die of cervical cancer, where it is the most common cancer affecting women. The disease illustrates a striking global health inequality. There are 274,000 deaths from cervical cancer each year and 80 per cent of them are in developing countries. Compared to the United States, Africa has nine times the incidence of cervical cancer. However, it has 24 times the mortality.
The incidence of cervical cancer appears to be increasing in the developing world, whereas incidence is falling in developed nations. This is largely due to systematic screening activity. In Britain, for example, women are now half as likely to be diagnosed with cervical cancer as they were when the NHS Cervical Screening Programme began in 1988. Also, a vaccination programme has recently been introduced.
One of the major barriers to tackling cervical cancer in Africa has been the prohibitive cost of screening and treatment. But that is now changing and so there is cause for new hope in the battle against the disease.
Early detection is crucial in combating cervical cancer. Although screening technology has existed for more than half a century, most women in Africa still have no access to cervical screening. By the time most women are diagnosed, they usually have advanced stage cancer and few have access to any form of treatment.
Screening based on cervical smears has not been feasible in Africa, due to the lack of necessary infrastructure. However, there are now effective low technology alternative methods of screening that can pick up pre-cancerous disease and allow treatment to get rid of these lesions and prevent the progression to cervical cancer.
In the past few years, there have also been some phenomenal improvements in screening technology, due to the development of low cost DNA tests aimed at detecting the human papilloma virus. And recent research suggests that, even if women in developing countries have access to just one screening in their lifetime, combined with treatment where required, this could reduce their risk of cervical cancer by up to a third.
Vaccines are also now available against two types of the human papilloma virus which cause around 70 per cent of cervical cancer cases. Protecting women against the virus requires vaccinating young women aged 10–12 three times in six months. This presents a unique challenge in Africa, where girls of this age may not be in school, where immunisation is easiest to administer. Currently, HPV vaccines are also expensive and beyond the reach of African countries. A course of vaccine jabs costs £300 per girl and this is away beyond the budget of African governments.
However, last month, AfrOx – an organisation that I co-founded with Former Labour Health Secretary Alan Milburn to improve cancer care in Africa – held an international conference to map out a strategy for cervical cancer prevention in Africa.
At the conference, representatives of Merck, one of the vaccine manufacturers, announced that they are committed to offering the HPV vaccine at a no-profit price. This is a fantastically generous offer which gives us a great opportunity to raise the necessary funds to get the vaccine onto the streets.
The AfrOx conference brought together health ministers from African nations, African doctors and advisors, the World Health Organisation, representatives from the pharmaceutical industry, leading international oncologists, major global cancer organisations and charities. These delegates are committed to global co-operation to eradicate cervical cancer in Africa. At the end of the conference, they issued “The Oxford Declaration”, calling for global support to provide the funds and expertise to eradicate cervical cancer in Africa.
Methods of prevention and treatment for cervical cancer are now becoming within the reach of African governments, and the AfrOx conference showed that there is also support from key stakeholders to achieve this end. So I believe that we have now reached a pivotal moment in the fight against cervical cancer in Africa.
But we must act now. We need to draw the widest possible attention to the magnitude of the problem of cervical cancer in Africa and call for immediate, co-ordinated and international action. Further, African Governments, NGOs and other international partners need to work together to implement cervical cancer screening and treatment programmes in Africa, taking into account the latest technology and ensuring equity of access for all women.
In Africa, cancer is currently a sentence to a painful and distressing death, but we can do something about it. Cervical cancer, in particular, is a largely preventable disease. The challenges are huge and many, but if we can bring together the necessary expertise and resources, we can save hundreds of thousands of lives.
David Kerr is professor of cancer therapeutics at the University of Oxford and co-founder of AfrOx. For more information about AfrOx, visit www.afrox.org
